Decoding Serious, Critical and Terminal Illness

Many people don’t know the difference between serious, critical and terminal illness until they have it. Here’s a guide to prepare you.
Jason Snyman
2018-07-04
Many people don’t know the difference between serious, critical and terminal illness. Most of the time, it takes becoming a patient yourself – or watching a loved one live through it – to fully understand what each of these mean. With regards to life insurance, things are often complicated enough as is – but they don’t need to be. Let’s begin by breaking down these three categories of ailment, and explaining each in the clearest way possible.
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Serious Illness

Serious illnesses walks hand in hand with critical illness – the chief distinction between them being the severity of the affliction and commonly – the amount of cover paid out. So therefore, we can define a serious illness as one that has the potential to kill you if gone untreated. But, because it can be diagnosed so quickly and treated so easily, patients are more likely to recover. If the person suffering fails to receive medical intervention in time, the sickness may progress and become life threatening. Then it’s a critical illness. When diagnosed with a serious illness, a patient may require hospitalisation. This may or may not require any surgical procedures to ensure a healthy recovery. The most important distinction here is that a serious illness, though often discomforting, is not immediately life threatening – provided that the affected person receives timely medical attention. Insurance companies offer a number of health plans to cover the hospital or medical expenses. Policies for both serious and critical illnesses cover a wide range of afflictions, and commonly pay out a lump sum amount. The amount paid might be significantly less than what you would receive with critical illness cover, but the chances of receiving the pay-out at all is far greater. Also, whereas critical cover doesn’t take the level of severity into account (just that it is severe in general) – serious illness cover does. The less severe your condition is, the less the pay-out will be.  

Critical Illness

Critical illnesses are life threatening and commonly require immediate hospitalisation. Though life threatening, with appropriate medical attention the disease could be cured or at the very least, controlled. At this stage, though, critical illnesses usually require specialised treatment which is quite expensive. Examples of critical illness include:
  • Kidney failure;
  • Multiple sclerosis;
  • Stroke;
  • Cancer;
  • Heart attack;
  • Liver disease;
  • Coma;
  • Organ transplant;
  • Brain surgery.
Depending on the treatment received, patients suffering from critical illness may be fortunate enough to fully recover. Alternatively, the disease may be kept in check long enough for the person to live a normal life. Cancer, for example, is a common critical ailment these days. If detected in time, certain types of cancer could be treated and the patient may enjoy a full recovery. For many other diseases there remains no cure at all. If detected in an early stage, the progress of these diseases may be slowed or halted with the right medication or changes in diet and lifestyle. Unfortunately, both scenarios are likely to cost you a lot of money. Insurance companies offer different kinds of cover for critical illnesses. These include policies for specialised critical illnesses and usually offer a lump sum payment to the insured upon diagnosis of the listed illness. This is important. The illness has to be listed in order to qualify. Even so, the diagnosis may have to meet certain criteria, such as severity, in order for the insurer to pay. The amount paid, though, is for the sum assured – completely separate from the actual cost of the treatment. You could put this money toward the lengthy treatment – or you could use it for whatever else you’d like. In many harrowing cases, critical illness goes untreated – and may advance to terminal illness. That means exactly what you think it means.
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Terminal Illness

When a person suffers from a life threatening disease with little to no chance of a cure, this is a terminal illness. In many cases, such a disease will lead to death within six months to a year. Terminal illnesses are commonly beyond treatment, with little in the way of slowing the progress or easing the suffering. With just a health insurance plan in place, insurers will pay the treatment and hospitalisation costs, or any related expenses. This is usually an assured lump sum amount paid out after the critical illness has been diagnosed or progressed to terminal illness. It’s often a wise choice to supplement this health insurance. Life insurance companies also offer term insurance plans, where the assured amount is paid out on death or diagnosis of the terminal illness. This diagnosis – or cause of death – has to be certified by an independent medical practitioner in order to ensure a pay-out. The medical certificate is then submitted to the insurance company along with any other necessary documents. In some cases, the insurer may even appoint its own independent medical practitioner to investigate the case. Once the insurer is satisfied that the insured is indeed terminally ill, with very little chance of survival, the company will pay the lump sum. Miracles, however, do occur – and sometimes terminal patients could recover against all odds.